A recent study determined that the risks associated with regular use of low dose aspirin may outweigh the benefits for many patients. The researchers determined that regular aspirin users were 10 percent less likely to have a heart event and 20 percent less likely to have a nonfatal heart attack. These statistics sound good except that regular aspirin users are also around 30 percent more likely to have serious gastrointestinal (GI) bleeding. The overall risk of death was the same for both patients who regularly used aspirin and those who did not.
This study looked at nine randomized studies of aspirin use and included more than 100,000 patients. The study only included patients who had not had a heart attack or stroke and involved giving participants either an aspirin or a placebo to see the benefits of regular doses of aspirin.
These findings have the potential to affect many people since nearly a third of middle-age Americans take a low dose aspirin regularly. Benefits from aspirin seem to outweigh the risks for people who have a history of heart attacks, but this study calls into question the benefits for patients who are hoping to prevent their first heart attack or stroke.
This issue can be analyzed by building a Cause Map, an intuitive, visual form of root cause analysis. In this example, the safety goal is the main goal that would be considered because of the higher risk of GI bleeding. The higher risk of bleeding is caused by the fact that patients are taking aspirin regularly and that GI bleeding is a known side effect of aspirin. People take aspirin because it has been shown to reduce the likelihood of blood clots. Reducing blood clots will in turn reduce the risk of heart attacks and stroke since blood clots have the potential to block flow to the brain or heart.
The conclusion that the study draws is that there is no one size fits all solution to the question of whether patients should regularly take low dose aspirin. The risks and potential benefits need to be determined on a case by case basis by the patient’s physician. For an individual with a strong family history of heart disease, the benefits may very well outweigh the risk of GI bleeding, but for others the use of aspirin may not be worth the risk.
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A study by the Office of the Inspector General (OIG) of the Department of Health and Human Services found that hospital employees are only reporting fourteen percent of all medical errors. Additionally, the study determined that processes are rarely changed to help prevent similar errors in the future.
The study was conducted by reviewing the medical records of Medicare patients. As a condition of participating in the Medicare program, hospitals are required by federal regulations to track medical errors that harm patients and to implement solutions to protect patients from similar mistakes in the future. All hospitals involved in the study had a method to collect information on medical errors, but all adverse events were not being efficiently captured by the systems in place.
The study found that out of 293 cases reviewed, only 40 were reported, 28 led to investigations and only five resulted in changes in the hospital’s processes. Additionally, the inspector general estimated that more than 130,000 Medicare beneficiaries experience at least one adverse event in a hospital in one month so there is a plenty of room for improvement in patient care.
The study found a number of reasons that adverse events and medical errors were not being reported. Confusion over requirements was one cause of the under reporting because hospital employees did not always recognize that a particular event harmed a patient and was required to be reported. Also, there were cases where employees assumed someone else would report the incident or they considered the incident to be so common that it didn’t need to be reported. There was also a tendency to not report things that were considered to be isolated events that were unlikely to recur.
To help combat these causes, the OIG report recommends the development of a standard list of medical errors that should be tracked and reported. The OIG also recommends that guidance be developed and provided for the accreditors of hospitals since they do not typically investigate adverse event collection methods. Additionally, some consumer groups are pushing for public reporting of medical errors to help pressure hospitals to improve their policies and practices.
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